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Asia Pacific Journal of Social Work and Development

ISSN: 0218-5385 (Print) 2165-0993 (Online) Journal homepage: http://www.tandfonline.com/loi/rswd20

Caring for my wife: voices from Malay olderhusbands in Singapore

Chang-Keun Han & Izarina Binte Jupri

To cite this article: Chang-Keun Han & Izarina Binte Jupri (2013) Caring for my wife: voicesfrom Malay older husbands in Singapore, Asia Pacific Journal of Social Work and Development,23:3, 215-221, DOI: 10.1080/02185385.2013.818201

To link to this article: http://dx.doi.org/10.1080/02185385.2013.818201

Published online: 25 Aug 2013.

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RESEARCH NOTE

Caring for my wife: voices from Malay older husbands in Singapore

Chang-Keun Hana* and Izarina Binte Juprib

aDepartment of Social Welfare, Faculty of Arts & Social Sciences, Sungkyunkwan University,Jongnogu Myeongnyundong, South Korea; bCare and Counselling Department, Medical SocialWorker, Tan Tock Seng Hospital, Singapore

(Received 13 February 2012; final version received 23 July 2012)

This study explores how Malay older husbands giving care to their wives in Singaporerespond to these roles through coping strategies and social support. This study uses in-depth interviews with five Malay older husbands whose wives are homebound becauseof dementia and kidney problems. Key findings suggest that husbands report lowcaregiver burden or strain. However, all the participants report that they do not taketime off from their caregiving roles because they have no other immediate sources ofsupport. Services relieving their caregiving responsibilities would be helpful to reducestress and prevent future burnout.

Keywords: Malay older husbands; caregiving to wives; caregiving roles and strains;in-depth interview

Introduction

While a considerable amount of research has examined the nature and levels of burden that

families have in caregiving, only a small number of studies have focused on older

husbands and their caregiving burden (Ducharme et al., 2007; Fuller-Jonap & Haley,

1995; Gurung, Taylor, & Seeman, 2003; Kramer & Lambert, 1999). This may be because

females (wives, daughters, and daughters-in-law) are considered to be natural caregivers

(Huang, 2004; Wong, Rong, Chen, Wei, & Lin, 2007). However, studies have emphasized

the pressing need for research on male caregivers, in particular those caring for their

wives, to understand the predictors and consequences of their caregiving (Ducharme et al.,

2007; Gurung et al., 2003). Research on older husbands’ caregiving to their older wives is

especially important given today’s modern context, wherein there are a growing number of

male older adults who make a sizable contribution to care for their wives (Baker &

Robertson, 2008).

Although this study is exploratory, two theoretical perspectives are considered to

explain male caregivers’ activity and its impacts on health and mental health. First, gender

socialization theory was introduced to explain different perception of caregiving to their

spouses. One study finds that some men may equate care with feminized activity and may

struggle to adjust themselves to caregiving roles (Baker, Robertson, & Connelly, 2010).

A few other studies, however, have found that older men occupy less polarized gender

roles and hold a less stereotyped image of caregiving (Crocker Houde, 2002;

Parsons, 1997). Male caregivers may perceive their caregiving activities as a duty,

‘a labour of love’, or a way of repaying what they received from their spouse before

q 2013 Department of Social Work, National University of Singapore, Singapore

*Corresponding author. Email: chkhan@skku.edu

Asia Pacific Journal of Social Work and Development, 2013

Vol. 23, No. 3, 215–221, http://dx.doi.org/10.1080/02185385.2013.818201

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her illness. In addition, they may consider caregiving of their sick wives as a primary

responsibility (Baker & Robertson, 2008; Ducharme et al., 2007). Second, the other

dimension of theoretical background is about impacts of husbands’ caregiving on their

health and well-being. However, the findings are mixed. Some researchers have found that

male caregivers are likely to have a higher rate of depression and lower levels of well-being

than male non-caregivers (Fuller-Jonap & Haley, 1995; Kramer & Lambert, 1999). These

findings suggest that caregiving is physically taxing and older male caregivers are at risk in

terms of health. These strains and complications may explain why some male caregivers

consider relinquishing their caregiving duties and institutionalizing their spouse (Ducharme

et al., 2007). The other group of researchers has found that husbands reported no negative

impacts of caregiving on their well-being or positive perceptions toward their caregiving

experience (Berg-Weger, Rubio, & Tebb, 2000; Chan, 2010).

Studies targeting caregiving by older husbands in Singapore are scarce. While informal

caregiving by family members is prevalent, the majority of caregivers for older adults are

female (Chan, 2010; Mehta, 2006; Teo, Mehta, Theng, & Chan, 2006). To address the

paucity of research on male caregivers of older spouses in Singapore, the current study

explores how Malay older husbands take care of their wives with dementia or health

limitations. The present study focuses on older husbands’ caregiving roles and how they

respond to these roles, such as coping strategies, social support and satisfaction. Cultural

factors may shape perceptions of familial responsibilities and thus, may also influence the

caregiving experience. This study uses in-depth interviews and a grounded theory approach

which may be useful to understand caregiving experiences of five Malay older husbands.

Since Malays are a minority in Singapore, findings of this study can provide empirical

evidence to develop culturally competent services for this disadvantaged population.

Methods

Participants

Participants in this study were conveniently and purposively selected through personal

invitation. Participants were selected according to the following selection criteria: (1)

Malay husbands aged 65 or above; (2) having wives with chronic illnesses (dementia or

kidney failure); (3) taking the primary caregiver’s role to their wives; (4) living

independently from other family members; (5) being physically competent tested with the

Activities of Daily Living (ADL) and the Instrumental Activities of Daily Living (IADL)

checklists. The final sample size was five. Key socio-economic characteristics of the

sample are presented in Table 1.

Interview and analysis

Semi-structured interviews were conducted with five participants in their respective homes

where they feltmost comfortable. Before beginning the interview,we explained the purpose

of the research, and respondents signed informed consent forms. The interview guideline

consisted of five components: background of participant and his family, personal autonomy

(roles and activities), social support/network, coping, and expressed satisfaction. All of

them have 6–10 specific items which are open-ended. The interviews were conducted in

Malay. The interview duration ranged from 50 to 60 minutes. The interviews were

transcribed verbatim and analysed individually using thematic coding, allowing themes to

emerge. All ethical considerations on this research were approved by the Institutional

Review Board (IRB) at National University of Singapore (NUS IRB 11-127).

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Results

Caregiving roles and husbands’ perceptions

Participants help their spouses with daily basic needs like going to the toilet, preparing

meals and cleaning the house. Some statements are excerpted from the interviews below.

Ever since she was diagnosed with kidney failure and has been confined to the wheelchair, shecannot do anything on her own anymore . . . .In short, everything in this house is done by me.(P4)

I basically help her with her daily needs, like going to the toilet, preparing meals, andeverything. She doesn’t leave the house alone now, most of the time if there’s anything weneed, I’ll hurry to the shop alone. (P3)

It is noteworthy that all participants considered taking care of wives as a responsibility.

Further, their perspective was that husbands and wives took turns caring for one another.

For me, caring for my wife is part of my responsibility as a husband. Besides I love my wifefor raising our children with me, so I guess it’s my turn to care for her now that she is sick. (P5)

When I was well she took care of our family without rest and tire, so now I see it as my turn tofulfil my part of the deal. (P1)

Despite their heavy responsibilities and stresses of caregiving, all of the participants

displayed a high degree of independence and low reliance on others in their daily decision

making.

I try my best to manage on my own. You know, be independent. I also don’t find the need to letothers know about my private matters. I think if I can do on my own, I’d rather do it myself.Why involve people unnecessarily? (P2)

I’d rather live on my own actually. I can do my own things without feeling I am depending onother people. More freedom, and I feel in control. (P3)

Challenges: caregiving strain and stress

Although husbands in this study expressed high levels of responsibility for and autonomy

in caregiving for their wives, it is inevitable that they faced many challenges and stresses

in their caregiving responsibilities. During interviews, three aspects of challenges were

identified.

Firstly, husbands are aged so that they suffered from physical strains. Most husbands

mentioned that physical strains were the primary challenge they had.

Table 1. Key characteristics of interview participants.

Husband’s

age

Wife’s

age

Husband’s

medical

condition

Wife’s

medical

condition

Housing

type

(HDB)

Number of

children

Length of

years in

providing care

P1 80 74 High blood

pressure

Dementia 3 rooms 8 (3 daughters,

5 sons)

5

P2 65 62 High blood

pressure

Kidney failure 3 rooms 7 (all daughters) 8

P3 65 65 Body ache Dementia 2 rooms 4 (all sons) 5

P4 68 62 Body ache Kidney failure 2 rooms 5 (3 daughters,

2 sons)

15

P5 72 65 Body ache Dementia 2 rooms 4 (all daughters) 6

Note: P denotes participant.

Asia Pacific Journal of Social Work and Development 217

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The main challenge is the physical, because it can get very tiring for me to take care of her. . . . My strengths and ability are also limited. My back aches and I need lots of rest (P5)

When I am sick, my leg hurts or I have a fever, I cannot take MC [Medical Certificate] frommy caregiving role. (P1)

However, it is interesting that the caregivers were unable to state explicitly the

illnesses they had and often conveniently classified their condition as ‘old people’s

illness’. They do not take their health ailments and illnesses seriously.

Secondly, some participants experienced emotional strain or loneliness.

Sometimes it tests my patience, and when I am ill there is no one else I can depend on.Basically it is the emotional strain, not other aspects that I am concerned about. (P3)

I sometimes can get very lonely not talking to or meeting anyone. (P5)

Thirdly, uncertainty about the future is one of the major stresses. Since they were old,

they worried about who would care for their wives if something should happen to them.

I am old, too, so I am not sure of how long I can cope with the physical demands of caregivingfor my wife. (P4)

It’s not that I cannot manage already, just that I don’t know what will happen in the future.I am getting old, don’t know what will happen to my wife if anything happens to me first. (P5)

Coping

All the participants coped by relying on their religious faith, which centred on believing

that every difficulty they faced would become manageable through worship to God. They

exercised positive thinking, as demonstrated by the following examples:

WeMalays, as you know, usually keep our issues to ourselves and find it hard to consult othersfor help. So mostly, we rely on family . . . . As Muslims, we must always be grateful with whatwe have. Every hardship and joy comes from God so we must accept it openly. (P1)

It helps to pray for strength and signs from God . . . . It’s also part of our religious beliefs toaccept our fate and what God has created for us. (P5)

I guess thinking positively helps, and believing that everything comes from God. In times ofneed, I think praying for strength and patience helps . . . by praying for strength I learn to copewith my difficulties better. (P2)

Social support and networks

It is interesting to note that all the participants perceived family as their main source of

social support. The most regular form of communication was with their family members,

particularly their adult children and grandchildren, although the frequency of contact

varied. Respondents prioritized family and children in all circumstances.

Because now they have husbands whom they must be filial to and children to care for, like lasttime, my wife dedicated her time to raising our children. It’s even harder nowadays, becausemy daughters have to balance outside work and taking care of their families. (P5)

My eldest son who lives nearby comes quite regularly to check on things, every month hetakes my wife for her medical check up. His wife is nice, too, often sends over cooked food forus . . . . My children provide me with financial help monthly, so they contribute. I’m gratefulbecause I still have filial children. (P1)

The participants generally were not receiving any formal assistance, such as support

from the Family Service Centres (FSC) or the community. The only form of assistance is

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emotional support provided mostly by their adult children. Participants did not receive any

help at all from anyone and relied mostly on themselves to meet their daily needs.

I don’t think I need any help, and if other people can help me. I think there are others who areworse off than me and need the help from all these sources. Let other people who deserve it getthe help. (P5)

I ask for help from my daughters when I cannot cope. As a last resort, so called . . . . I don’tbelieve in telling outsiders because people will not understand my personal issues. I thinkbetter keep family issues within the people you are close to. (P5)

Expressed satisfaction

Participants were generally satisfied with their current situation, which may be mainly

attributed to their religious beliefs and positive thinking as discussed at the coping section

above.

Well. I think I am rather satisfied. I have good health, for someone with my age. I have a bigfamily who respects me and many grandchildren to keep me entertained when they visit. I stillhave a wife although she is not well. I have a place for shelter and enough money to continueto survive day by day. What more can I ask for? (P3)

I would say I am satisfied, because my life could have been harder and I could be challengedmore in life. Right now, I have children who still care about me and I have enough food to eatand shelter for myself and my wife, so I am happy. (P1)

Discussion and conclusion

This exploratory study has several limitations: a small sample size, no representativeness

of Malay older husbands, a possible self-selection bias, and a cross-sectional design. The

findings of this study should be understood with the limitations.

Despite the limitations, the findings of this study are noteworthy. Here, we summarise

several key themes that emerged from the interviews. First, contrary to a culturally

stereotyped perception where males may struggle to cope with caregiving to their spouse,

Malay older adults accept their caregiving roles as responsibilities and payback to what

they had received from their spouse. These findings suggest that Malay older adults do not

have stereotyped images of caregiving to their wives and consider the caregiving as their

primary responsibility (Baker & Robertson, 2008; Crocker Houde, 2002; Ducharme et al.,

2007). Second, accordingly, they have expressed a very low level of caregiving burdens.

These findings are consistent with studies where caregiving husbands report no negative

perceptions of giving care to their wives and no negative impacts on husband’s well-being

(Berg-Weger et al., 2000; Chan, 2010). Third, the low caregiver burden experienced by the

male Malay caregivers can be attributed to the cultural values of the Malays who recognize

caregiving as a salient part of family life. They believed that they need to accept the

situations. In a collectivistic and communal culture like the Malays, the importance of

family bonds is heavily propounded. There is a strong connection and interdependence

amongst family members. For Malay husbands, they tried to promote the communal

nature of the relationships by caring for their sick wife (Clark & Monin, 2006; Dion &

Dion, 2006). In doing so, male older adults regarded caregiving to their wife as the paying

back of their wife’s contributions when they were still well (Antonucci, 1990). Last, the

prevalent coping strategy used by the respondents was through spiritual faith that was

manifested in acts of worship to God. Religion is a salient psychosocial resource that

provides the caregivers with a way to deal with the strains of caregiving. In particular, the

concept of fate and predestination reduced difficulties associated with caregiving since

their responsibilities mean a test from God which should be embraced with optimism and

Asia Pacific Journal of Social Work and Development 219

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courage. Dismissing their caregiving obligations is akin to a rejection of God’s will.

Religious obligations may cement their unconditional caregiving responsibilities. Since

belief in God leads to positive thinking, they are in general satisfied with caregiving to

their spouse and their current situations.

However, these findings do not discount older husband’s needs for social services to

enhance their quality of life. Despite no negative impacts on the well-being of husbands,

they are concerned about their physical health, emotional strain and worries about their

own death. All the participants reported that they do not take time off from their caregiving

roles because they have no other immediate sources of support. They also displayed a lack

of knowledge of the available support resources and showed heavy reliance on their

children to communicate with external parties such as medical professionals. Thus, it

would be helpful if they gain access to information and assistance in a language that they

are comfortable with (i.e. Malay) (Maslow & Selstad, 2001). Emotional and psychosocial

supports can be provided through social service sectors. The support can include in-home

or out-of-home respite programmes such as day care programmes. There is evidence that

out-of-home daytime respite reduces caregivers’ physical and emotional distress (Gaugler

& Zarit, 2001). In particular, in-home respite care may help delay institutionalization of

individuals with Alzheimer’s disease or other forms of dementia (Gaugler et al., 2000;

Kosloski & Montgomery, 1995; Sorensen, Pinquart, & Duberstein, 2002).

A wide variety of caregiver services exist nationwide in Singapore. However, it is

important to ensure that these services cater to the needs and abilities of older adults. This

is especially so for the minority groups in Singapore. It is understandable that programme

administrators may face various constraints in implementing caregiver services, such as

workforce shortage (e.g. Malay or Malay-speaking social workers), need for additional

outreach efforts, growing diversity among caregiver needs and limited collaboration

among service providers (Feinberg, Newman, Gray, Kolb, & Fox-Grage, 2004). However,

identifying the needs of older adults may be crucial to ensure better effectiveness and

utilization of the services provided. In an Asia-Pacific region where family caregiving is

prevalent and racial diversity is increasing, this study suggests that social services should

be initiated to meet different needs of caregiving considering diverse racial and cultural

contexts (Wood & Parham, 1990).

Notes on contributors

Dr Chang-Keun Han is an associate professor of the Department of Social Welfare, SungkyunkwanUniversity in Korea.

Izarina Binte Jupri is a medical social worker at Tan Tock Seng Hospital in Singapore.

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